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Follicular cell-derived thyroid cancer

Abstract

Follicular cell-derived thyroid cancers are derived from the follicular cells in the thyroid gland, which secrete the iodine-containing thyroid hormones. Follicular cell-derived thyroid cancers can be classified into papillary thyroid cancer (80–85%), follicular thyroid cancer (10–15%), poorly differentiated thyroid cancer (<2%) and undifferentiated (anaplastic) thyroid cancer (<2%), and these have an excellent prognosis with the exception of undifferentiated thyroid cancer. The advent and expansion of advanced diagnostic techniques has driven and continues to drive the epidemic of occult papillary thyroid cancer, owing to overdiagnosis of clinically irrelevant nodules. This transformation of the thyroid cancer landscape at molecular and clinical levels calls for the modification of management strategies towards personalized medicine based on individual risk assessment to deliver the most effective but least aggressive treatment. In thyroid cancer surgery, for instance, injuries to structures outside the thyroid gland, such as the recurrent laryngeal nerve in 2–5% of surgeries or the parathyroid glands in 5–10% of surgeries, negatively affect quality of life more than loss of the expendable thyroid gland. Furthermore, the risks associated with radioiodine ablation may outweigh the risks of persistent or recurrent disease and disease-specific mortality. Improvement in the health-related quality of life of survivors of follicular cell-derived thyroid cancer, which is decreased despite the generally favourable outcome, hinges on early tumour detection and minimization of treatment-related sequelae. Future opportunities include more widespread adoption of molecular and clinical risk stratification and identification of actionable targets for individualized therapies.

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Figure 1: Macroscopic appearance of the types and subtypes of follicular cell-derived thyroid cancer.
Figure 2: Sex-specific incidence and mortality rates for thyroid cancer by region.
Figure 3: Variability and trends in thyroid cancer incidence in women in countries with a high Human Development Index.
Figure 4: Signalling pathways involved in follicular cell-derived thyroid cancer development and progression.
Figure 5: Diagnosis of follicular-derived thyroid cancers.
Figure 6: Operative view of total thyroidectomy with en bloc central compartment dissection in node-positive papillary thyroid cancer.

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Contributions

Introduction (H.D. and A.M.); Epidemiology (S.F.); Mechanisms/pathophysiology (Y.E.N.); Diagnosis, screening and prevention (I.D.H. and V.F.); Management (H.D., A.M., F.P. and S.I.S.); Quality of life (J.B. and J.L.P.); Outlook (F.P.); Overview of Primer (H.D.).

Corresponding author

Correspondence to Henning Dralle.

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Competing interests

Y.E.N. declares that he has received consulting fees from Quest Diagnostics. S.I.S. declares that he has received consulting fees from Bayer, Eisai and Exelixis. All other authors declare no competing interests.

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Dralle, H., Machens, A., Basa, J. et al. Follicular cell-derived thyroid cancer. Nat Rev Dis Primers 1, 15077 (2015). https://doi.org/10.1038/nrdp.2015.77

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